Cellulitis is an acute inflammatory condition of the skin that is characterized by localized pain, redness, swelling, and rise in temperature of that particular area of inflammation. The commonest organisms that cause cellulitis are staphylococcus and streptococcus and they being the commonest organism, the treatment is generally targeted at killing these organisms.
The primary treatment (first line treatment) of cellulitis:
The first line treatment of cellulitis is with newer penicillin. Among newer penicillins Nafcillin or oxacillin at the dose of 2 gram intravenously every 4 to 8 hourly is the drug of choice.
Second line treatment of cellulitis:
Second line treatment of cellulitis is with cephalosporins, other semi-synthetic penicillins or with drugs like erythromycin. Among cephalosporins the drug of choice is Cefazolin, (dose 1 to 2 gram every 8 hourly). Ampicillin + sulbactam (semisynthetic penicillin) or Erythromycin, 0.5 to 1.0 gram intravenously every 6 hourly or Clindamycin, 600–900 mg intravenously every 8 hourly can also be used as second line drug for treatment of cellulitis.
The resistance to antibiotics like erythromycin is a problem in treatment of infections like cellulitis. The frequency of erythromycin resistance in group A Streptococcus is very common and currently approximately 5% in the United States but has reached as high as 70% to 100% in many countries. Most (though not all), erythromycin-resistant group A streptococci are susceptible to clindamycin. Approximately 90% to 95% of Staphylococcus aureus (which also cause cellulitis) strains are sensitive to clindamycin.
Cellulitis is a common clinical problem. Cellulitis is an acute inflammatory condition of the skin, generally caused by infection. The typical characteristic features of Cellulitis are localized pain, erythema (redness), swelling, and heat at the area of inflammation.
Causative agents of Cellulitis:
Cellulitis can be caused by indigenous flora which colonizes the skin and appendages like Staphylococcus aureus and Streptococcus. Pyogenes. Other species of staphylococcus and streptococcus also cause cellulites. It can also be caused by variety of other exogenous organisms, mainly bacteria like Pseudomonus aeruginosa, Pasteurella multocida (commonly cat bite and less commonly dog bite), Capnocytophaga canimorsus, Eikenella corrodens, Aeromonas hydrophila etc.
Route of entry of causative organism in Cellulitis:
Bacteria generally gain access to the epidermis through cracks in the skin, which is mainly due to abrasions, cuts, burns, insect bites, surgical incisions, and intravenous catheters. Different organisms gain entry by different routes, e.g. cellulitis caused by S. aureus spreads from a central localized infection, like an abscess (folliculitis), or from an infected foreign body like a splinter, a prosthetic device, or an intravenous catheter.
Diagnosis of cellulites:
Due to the involvement of exogenous bacteria in cellulites, a thorough history including epidemiologic data can provides important clues to the infecting organism. Whenever possible, a Gram’s stain and culture of the pus which is collected during drainage can provide a definitive diagnosis. If pus can not be cultured or Gram’s stain can not be done, it is very difficult to establish a diagnosis due to the similarity of the clinical features in staphylococcus and streptococcus cellulitis. Even with needle aspiration of the leading edge or a punch biopsy of the cellulitis tissue itself, cultures are positive in only 20% of cases, which suggest only small numbers of bacteria cause cellulites. The expanding area of redness within the skin may be a direct effect of extra-cellular toxins or due to the soluble mediators of inflammation.
Generic drugs are same as that of a brand name drug. The only difference is that patent protection is not available to generic drugs as that of brand drug. As far as quality and efficacy of generic drugs is concerned there is no difference in generic drug from a non generic or brand name drug. Generic drugs are same as that of brand name drugs in terms of its therapeutic use, dosage, route of administration, risks and side effects, safety and strength as that of the original drug (brand name drug). Many people think that generic drugs are inferior in quality (as many think they are produced in poorer quality facilities and inferior quality) in compare to brand name drugs, but it is a myth and there is no truth in it.
USFDA regards generic and brand name drugs as equal and they apply the same standards for quality control of both generic and brand name drugs. Same standards are used for all drug manufacturing facilities and according to FDA 50% of generic drugs are produced by brand-name companies, many of them are in the same manufacturing facilities.
The list genric drug names is very long and becoming longer day by day, due to removal of patent protection from many brand name drugs after the expiry of patent right. Many generic drugs are available these days like generic Viagra, generic propecia, generic xenical and many more.
The advantages of generic drug are the low cost of the drug as it can be produced and distributed (sold) by any company without any patent obligation. The quality and efficacy of the generic drugs are same as that of bran name drugs.
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Cephalexin is a cephalosporin group of antibiotics. It is available as Keflex tablet. It belongs to first generation cephalosporin and it is orally effective, as the oral absorption of this antibiotic is excellent. Cephalosporin group of antibiotics are semi-synthetic and is derived from “cephalosporin-C” which is obtained from fungus Cephalosporium. Cephalosporin group of antibiotics are chemically related to penicillin. Both penicillin group and cephalosporin group contain beta-lactam ring in its structure. Like many other prescription drugs, Keflex is available only by producing a prescription and it is not available over the counter.
Antibacterial activity of Keflex:
Keflex antibiotic is active against many organisms (bacteria) namely streptococci (causes sore throat), staphylococci (causes skin infection like boils, furuncles etc.), gonococci (causes gonorrhea), meningococci (causes meningitis), chorinebacterium diptheriae (causes diptheria), clostridium (causes botulism, food poisoning etc.) and actinomyces.
Therapeutic uses of Keflex:
- The most important use of Keflex is as alternative to penicillin.
- It can be used in treatment of respiratory tract infection (both upper as well as lower respiratory tract infection), urinary tract infection as well as soft tissue infection.
- Bacterial infections which are resistant to penicillin (by producing enzyme penicillinase, which destroy penicillin) can be treated with Keflex.
- Keflex can also be used in prophylaxis of patients who will undergo surgery.
- Keflex is excellent in curing gonorrhea.
- It is effective in treatment of typhoid also.
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Folliculitis is infection and inflammation of hair follicles. Hair follicles are present all over the body except palms and soles. So practically Folliculitis can occur anywhere in the body except palms and soles. Hair follicles are portals of large number of bacteria.
Causative organisms of Folliculitis:
The commonest organism of Folliculitis is Staphylococcus aureus and it usually causes localized folliculitis. Other causative organisms are Pseudomonas aeruginosa, Propionibacterium acnes (causative organism of acne or pimples), Schistosoma species etc.
Diffuse folliculitis can occur in two settings, “hot-tub” folliculitis and “swimmer’s itch”. Hot-tub folliculitis occurs when waters is insufficiently chlorinated and maintained at temperatures of 37–40°C and the infection is generally self limiting (although bacteremia and shock may occur rarely). The causative agent in hot-tub folliculitis is Pseudomonas aeruginosa.Swimmer’s itch occurs when a skin surface is exposed to water infested with freshwater avian schistosomes (Schistosoma species). Free-swimming schistosomes can readily penetrate human hair follicles but quickly die and elicit a brisk allergic reaction which cause intense itching and erythema.
Sebaceous glands empty into hair follicles and ducts and if they are blocked they form sebaceous cysts, which may resemble staphylococcal abscesses. Chronic folliculitis is uncommon except in acne vulgaris (a form of folliculitis), which is generally caused by normal flora Propionibacterium acnes.
Treatment of folliculitis:
If the organisms are sensitive to beta-lactum antibiotics, they should be used first. Examples of beta-lactum antibiotics are penicillins (older and newer synthetic penicillin like amoxycillin), cephalosporins (like Cefazolin) etc. If the organisms are not sensitive to beta-lactum antibiotics, vancomycin (1 gm intravenously every 12 hourly) or linezolid (600 mg intravenously every 12 hourly) should be used. Sometimes tetracycline and trimethoprim-sulfamethoxazole can also be used.